芒硝外敷预防儿童ERCP术后胰腺炎的临床研究

Clinical study on external application of Natrii Sulfas to prevent post-ERCP pancreatitis in children

目的观察芒硝外敷对儿童内镜逆行性胰胆管造影(ERCP)术后胰腺炎(PEP)的预防作用。方法将150例拟行ERCP术的胆胰疾病患儿随机分为治疗组和对照组,每组75例。两组均按操作规范行ERCP术,治疗组在术前30 min给予芒硝外敷并持续使用至术后24 h。观察PEP发生率,比较术后VAS疼痛评分及血清肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、二胺氧化酶(DAO)、D-乳酸水平的变化情况。结果(1)治疗组、对照组PEP发生率分别为5.3%、18.7%,治疗组PEP发生率低于对照组(P<0.05)。(2)术后24 h组间比较,治疗组VAS疼痛评分低于对照组(P<0.05)。(3)术后24 h与术前3 h组内比较,两组血TNF-α、IL-6水平升高(P<0.05),血DAO、D-乳酸水平降低(P<0.05);术后24 h组间比较,治疗组血TNF-α、IL-6、DAO、D-乳酸水平均低于对照组(P<0.05)。结论芒硝外敷能有效预防PEP的发生并减轻ERCP术后疼痛,对胰腺组织有一定的保护作用,其机制可能与改善炎症反应、保护肠黏膜屏障功能有关。

Objective To observe the preventive effect of external application of Natrii Sulfas on post-ERCP pancreatitis(PEP)in children.Methods A total of 150 children with cholangiopancreatic diseases undergoing ERCP were randomly divided into treatment group(n=75)and control group(n=75).ERCP was performed according to the operation standard in both groups.In the treatment group,Natrii Sulfas was applied externally 30 minutes before operation and continued to be used until 24 hours after operation.The incidence of PEP was observed,and the postoperative VAS pain score and the changes of blood tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),diamine oxidase(DAO)and D-lactic acid were compared.Results(1)The incidence of PEP in the treatment group and the control group was 5.3%and 18.7%respectively,and the incidence of PEP in the treatment group was lower than that in the control group(P<0.05).(2)The VAS pain score in the treatment group was lower than that in the control group 24 hours after operation(P<0.05).(3)Compared with the results 3 hours before operation,the levels of blood TNF-αand IL-6 increased and the levels of DAO and D-lactic acid decreased in both groups 24 hours after operation(P<0.05).Otherwise,the levels of blood TNF-α,IL-6,DAO and D-lactic acid in the treatment group were lower than those in the control group 24 hours after operation(P<0.05).Conclusions External application of Natrii Sulfas can effectively prevent the incidence of PEP,relieve post-ERCP pain and protect pancreatic tissues to some extent.The mechanism may be related to its functions of improving inflammatory response and protecting intestinal mucosal barrier.